Chaila et al1 described patients with dopa-responsive dystonia (DRD) and extensor plantar responses in 3 of 4 patients, brisk lower limb reflexes in all 4, and spasticity in 1 patient. The hyperreflexia decreased and the plantar responses became flexor within 6 to 12 months of treatment in the patients in whom these signs were initially present. The authors concluded that DRD may cause early-onset dystonia with extrapyramidal or pyramidal tract dysfunction. However, we want to discuss that both reflexive dorsal extension of the great toe and hyperreflexia of tendon reflexes may be caused by dystonia itself rather than by dysfunction of the pyramidal tract. Dystonic pseudo-Babinski and pyramidal Babinski may be caused by different neurophysiological mechanisms.
Horstink MWIM, Haaxma C, Bloem BR, Duysens J. Babinski, Pseudo-Babinski, and Dystonia. Arch Neurol. 2007;64(8):1207–1209. doi:10.1001/archneur.64.8.1207